Surgery For Congenital Heart Defects Research Articles

Motor Outcome After Early Surgery for Congenital Heart Defects (CHD): A Systematic Review

Abstract Date Presented 04/05/19 Congenital heart defects (CHD) are the most common congenital defects in newborn infants. Infants with CHD are at higher risk of having motor developmental delays, especially in infants less than six months old. Early identification of delays can lead to early referral for OT and could help in changing the trajectory of the motor delays and improve the quality of life for children with CHD. Primary Author and Speaker: Turki Aljuhani Additional Authors and Speakers: Patty Coker-Bolt Contributing Authors: Dorothea Jenkins, Heather Bonilha

Incidence Of Acute Kidney Injury Following Cardiac Catheterization in Early Post-Operative Period in Children With Congenital Heart Disease.

Background: Cardiac catheterization (CC) is commonly performed following surgery for congenital heart defects (CHD) for diagnosis and intervention of residual lesions. Use of contrast during CC increases risk for acute kidney injury (AKI), although data are lacking. Our purpose was to evaluate the incidence and risk factors of AKI in pediatric patients who underwent CC within 14 days after CHD surgery with cardiopulmonary bypass (CPB). Methods: This was a retrospective chart review ofall children CHD surgery with CPB at a single Children';s Hospital. Patients known to have renal failure were …

Abstract 3305: Cancer mortality in children surviving congenital heart surgery: A study from the pediatric cardiac care consortium

Abstract Introduction: Children with congenital heart defects (CHD) are a unique population with abbreviated survival compared to the general population. Case-control studies have suggested an elevated risk of childhood cancer in children with CHD. This has not been evaluated in prospective studies nor has risk of cancer in adult survivors of CHD. This study describes mortality from cancer among survivors of CHD in the Pediatric Cardiac Care Consortium (PCCC). Methods: We performed a retrospective cohort study of individuals who underwent surgery for CHD at 0-21 years of age in the PCCC during 1982-2003. Patients surviving their first CHD surgery (n= 35,998) were linked to the National Death Index (NDI) through 2014. Cancer mortality was compared to that in the general population using standardized mortality ratios (SMRs) matched on age, year, and sex. Results: Seventy patients were identified as having an underlying cause of death as cancer and surviving a CHD operation in the PCCC (males, n=38). Of these, 17 (24.3%) had a diagnosis of Trisomy 21. Deaths occurred over a median follow-up of 8.81 years (IQR: 5.9-15.8) post hospital discharge with median age at death of 13.5 years (IQR: 7.0-20.0). Overall adjusted SMRs for deaths relating to cancer were 2.75 (95% CI: 2.11-3.40) and increased for those with a chromosomal abnormality (2.31 to 6.76). Decrease in mortality was observed the older the patient was at CHD surgery (neonate to adolescence: 5.03 to 1.65 respectively). Increased mortality in surgically severe CHDs (SMR: 4.75; 95% CI: 2.26-7.23) was seen. Conclusions: The PCCC-NDI linked database leverages the largest cohort of children with CHD in the U.S. We found an increased risk of death from cancer, especially in those with chromosomal abnormalities. This may demonstrate an increased risk of cancer, but could indicate higher risk of death from cancer for children who previously had CHD. To resolve these possibilities we will link to cancer registries to obtain incident disease. N (%)SMR95% CIOVERALL702.75(2.11-3.40)Lesion GroupLeft-to-Right Lesions36 (51.4)2.82(1.90-3.75)Impaired Systemic Flow13 (18.5)2.71(1.23-4.18)Impaired Pulmonary Flow7 (10.0)2.52(0.65-4.39)Complex Lesions3 (4.3)2.07(0.0-4.42)Anomalous Pulmonary Venous Return2 (2.9)5.92(0.0-14.12)Transposition Physiology2 (2.9)2.74(0.0-6.55)Other4 (5.7)2.38(0.05-4.71)Single Ventricle3 (4.3)3.74(0.0-7.98)Age at SurgeryNeonate12 (17.2)5.03(2.19-7.88)Infant17 (24.3)3.14(1.65-4.63)Child22 (31.4)3.59(2.09-5.10)Adolescent19 (27.1)1.65(0.91-2.40)Chromosomal AbnormalityYes17 (24.3)6.76(3.55-9.97)No53 (75.7)2.31(1.69-2.94)SeverityModerate28 (40.0)2.99(1.88-4.10)Mild22 (31.4)2.21(1.29-3.13)Severe14 (20.0)4.75(2.26-7.23)N/A6 (8.6)1.91(0.38-3.43) Citation Format: Amanda S. Thomas, Logan Spector, Lazaros K. Kochilas. Cancer mortality in children surviving congenital heart surgery: A study from the pediatric cardiac care consortium [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3305.

Short stature among children undergoing cardiac surgery for congenital heart defects.

Children with congenital heart diseases (CHDs) suffer from malnutrition because of nutritional deficiencies, being short stature the possible long-term consequence. To describe the presence of short stature among children undergoing cardiac surgery for CHDs. Retrospective study. Children undergoing cardiac surgery with cardiopulmonary bypass pump between 2009 and 2013 were included. Preterm infants, carriers of genetic syndromes or other disease with nutritional compromise were excluded. Demographic data, type of CHD, admission surgery and anthropometric assessment using the WHO standards were studied. Short stature was defined as lenght/height for age Z score < -2 standard deviations, by sex. A total of 640 children were studied; 361 (56.4 %) were boys; median age: 8 months (IQR: 1.9; 34.6); 66 children underwent > 1 surgery; 27 of them (40.9 %) had hypoplasia of the left ventricle. There were 358 (55.9 %) infants with cyanotic CHDs, 196 (30.6 %) with univentricular physiology. The median HAZ was -0.9 (IQR: -1.9; -0.1); 135 (21.1 %) had a short stature, 11 % of newborn infants and 24.1 % of older than one month old. A higher frequency of short stature was observed in 4 out of 6 children who underwent complete repair of the atrioventricular canal, in 15 out of 39 infants with repair of tetralogy of Fallot, in 8 out of 25 infants with hypoplasia of the left ventricle subjected to Glenn procedure, and in 34 out of 103 with closure of the ventricular septal defect. No association or statistically significant difference was found between short stature and cyanosis or univentricular physiology. There is a high frequency of short stature among children with CHDs, with differences according to the type of CHD and cardiac surgery performed.

Critical appraisal of MAPSE and TAPSE usefulness in the postoperative assessment of ventricular contractile function after congenital heart defect surgery in infants.

IntroductionIn this study, we assessed the adequacy of the two echocardiographic parameters representing the longitudinal systolic function of the ventricles, MAPSE & TAPSE, in perioperative monitoring.Aims1. The assessment of MAPSE and TAPSE during the early (4 weeks) postoperative period after surgical correction of congenital heart defects in infants, performed with CPB. 2. The verification of the hypothesis, that the significant decline of TAPSE observed in this period is not related to the global RV systolic dysfunction. For this reason, systolic function of the RV was additionally assessed with another echocardiographic parameter: RVFAC.Material and methodsProspective study with 51 infants operated due to ASDII, VSD, AVSD and TOF. Four measurements of MAPSE,TAPSE and RVFAC were performed in the apical four-chamber projection. TAPSE and MAPSE were expressed as metric values and z-score; RV FAC values were expressed in percentages.ResultsTAPSE uniformly declined in the first postoperative day down to 34.5% of the initial value (p <0.00001), then gradually increased: up to 42.9% and 52% respectively, remaining significantly lower than preoperatively (p <0.001). RV FAC: increased by 21% (p <0.01), then remained stable in consecutive examinations. MAPSE declined by 21% during the first postoperative day, but with promptly normalized completely.ConclusionsThe movement of both AV valve annuli is subjected to different, not fully understood influences. The relatively slight decline of MAPSE makes this parameter suitable for the assessment of the postoperative LV systolic function. Deep, long-lasting decline of TAPSE, uniform in the whole group, does not permit to use this parameter and suggests the choice of another one, e.g. RVFAC.

Attitudes of clinicians toward cardiac surgery and trisomy 18.

Trisomy 18 is an autosomal trisomy condition characterized by minor to major birth defects, severe disabilities, and high rates of pre- and postnatal mortality. Interventions for these infants have traditionally been withheld with focus instead on palliative support. The issues and attitudes surrounding corrective surgery of congenital heart defects, which is a birth defect that occurs in approximately 90% of infants with trisomy 18, is of our study's interest as recent literature has indicated that cardiac surgery is being performed and may lead to improved survival compared to palliative care. Thus, our study aimed to describe clinician attitudes toward cardiac surgery and trisomy 18. We surveyed 378 clinicians from multiple specialties, including genetic counselors, involved in the pre- and postnatal care of infants with trisomy 18. Descriptive statistics were performed to describe all clinicians' responses, and a secondary analysis with stratifications by clinician type was also performed. Forty-eight percent (n=378) of clinicians felt it was appropriate to discuss the option of cardiac surgery. Ethical concerns and insufficient outcome data were the most agreed upon reasons for not offering cardiac surgery. Trisomy 18 not being uniformly lethal and expressed parental wishes were the most agreed upon justifications for offering surgery. Clinicians felt the discussion of the option of cardiac surgery is appropriate, however are hesitant due to ethical concerns and insufficient outcome data. Results from this study aim to promote discussion and collaboration among clinicians to improve consistency in patient care.

A retrospective study of surgical outcomes of various congenital heart diseases at tertiary care center, SMS Hospital, Jaipur, Rajasthan, India

Paediatric cardiac surgery is still in growing phase in India and the expert and trained personnel for paediatric cardiac surgery is insufficient for congenital heart defects (CHD) cases. Moreover, various types of surgeries have been performed for different CHDs, and the surgical outcomes vary according to the complexity of CHD. There is continuous improvement in outcome of CHD surgery as advancement of surgical technique and post operative care with the time. However, the available data on CHD surgical outcome is limited in India. This paper defines procedure performed for particular CHD, their weightage, age group-wise distribution and the outcome of respective procedures. The paper also analyses result of surgeries performed for CHD at tertiary care centre.

Did Malnutrition Affect Post-Operative Somatic Growth in Pediatric Patients Undergoing Surgical Procedures for Congenital Heart Disease?

This study aims to investigate the impact of pre-operative malnutrition on nutritional outcome following congenital heart defects surgery. This is a prospective cohort study. Pediatric Cardiac Intensive Care, Harapan Kita National Cardiovascular Center, Jakarta, Indonesia. Pediatric patients, aged younger than 36months old with Aristotle score of 6-10, undergoing congenital heart defects surgery with cardiopulmonary bypass were included in this study. The measured outcome was nutritional outcome based on body weight changes before and after corrective surgery. The measured variables were age, gender, Aristotle score, caloric intake (in pediatric cardiac intensive care unit and pediatric ward), length of stay, albumin level, and prealbumin level. Among 185 patients, 6% increase of body weight was observed within 12days of observation (p = 0.007). From bivariate analysis, post-operative nutritional status improvement was significantly associated with pre-operative Z-score for weight-for-age (p = 0.011), caloric intake in pediatric ward (p < 0.0001), and prealbumin level (p = 0.038). From multivariate analysis, caloric intake in pediatric ward remained as a factor which significantly determined post-operative nutritional status (p = 0.001, OR = 1.33, 95% CI 1.014-1.053). Malnourished patients may have significant improvement in somatic growth following corrective surgery but no effect was observed on the post-operative body weight gain. Adequate nutritional support is important to ensure optimal recovery and better nutritional outcome.

Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death Index.

BackgroundPrior research has focused on early outcomes after congenital heart surgery, but less is known about later risks. We aimed to determine the late causes of death among children (<21 years of age) surviving their initial congenital heart surgery.Methods and ResultsThis is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a US‐based registry of interventions for congenital heart defects (CHD). Excluding patients with chromosomal anomalies or inadequate identifiers, we matched those surviving their first congenital heart surgery (1982–2003) against the National Death Index through 2014. Causes of death were obtained from the National Death Index to calculate cause‐specific standardized mortality ratios (SMRs). Among 31 132 patients, 2527 deaths (8.1%) occurred over a median follow‐up period of 18 years. Causes of death varied by time after surgery and severity of CHD but, overall, 69.9% of deaths were attributed to the CHD or another cardiovascular disorder, with a SMR for CHD/cardiovascular disorder of 67.7 (95% confidence interval: 64.5–70.8). Adjusted odds ratios revealed increased risk of death from CHD/cardiovascular disorder in females [odds ratio=1.28; 95% confidence interval (1.04–1.58); P=0.018] with leading cardiovascular disorder contributing to death being cardiac arrest (16.8%), heart failure (14.8%), and arrhythmias (9.1%). Other major causes of death included coexisting congenital malformations (4.7%, SMR: 7.0), respiratory diseases (3.6%, SMR: 8.2), infections (3.4%, SMR: 8.2), and neoplasms (2.1%, SMR: 1.9).ConclusionsSurvivors of congenital heart surgery face long‐term risks of premature mortality mostly related to residual CHD pathology, heart failure, and arrhythmias, but also to other noncardiac conditions. Ongoing monitoring is warranted to identify target factors to address residual morbidities and improve long‐term outcomes.

Congenital heart defect repair with ADAPT tissue engineered pericardium scaffold: An early-stage health economic model.

ObjectiveThe objective of this study was to evaluate the cost effectiveness of tissue engineered bovine tissue pericardium scaffold (CardioCel) for the repair of congenital heart defects in comparison with surgery using xenogeneic, autologous, and synthetic patches over a 40-year time horizon from the perspective of the UK National Health Service.MethodsA six-state Markov state-transition model to model natural history of disease and difference in the interventional effect of surgeries depending on patch type implanted. Patches differed regarding their probability of re-operation due to patch calcification, based on a systematic literature review. Transition probabilities were based on the published literature, other clinical inputs were based on UK registry data, and cost data were based on UK sources and the published literature. Incremental cost-effectiveness ratio (ICER) was determined as incremental costs per quality adjusted life years (QALY) gained. We used a 40-year analytic time-horizon and adopted the payer perspective. Comprehensive sensitivity analyses were performed.ResultsAccording to the model predictions, CardioCel was associated with reduced incidence of re-operation, increased QALY, and costs savings compared to all other patches. Cost savings were greatest compared to synthetic patches. Estimated cost savings associated with CardioCel were greatest within atrioventricular septal defect repair and lowest for ventricular septal defect repair. Based on our model, CardioCel relative risk for re-operations is 0.938, 0.956and 0.902 relative to xenogeneic, autologous, and synthetic patches, respectively.ConclusionCardioCel was estimated to increase health benefits and save cost when used during surgery for congenital heart defects instead of other patches.

How good are we in predicting the risk of infant mortality for newborns undergoing “curative” surgery for structural congenital heart defects? A prospective, population-based cohort (EPICARD) study

Currently accepted birth prevalence for osteochondrodysplasias (OCDs) is about 2 per 10,000 births. Our main goal is to estimate the prevalence of OCDs in Argentina and compare it with other surveillance systems. We examined 1,663,610 births among 160 hospitals of RENAC (Red Nacional de Anomalías Congénitas - National Network of Congenital Anomalies) between November 2009 and December 2016. Cases were detected and registered according to a pre-established protocol, ranked in three diagnostic evidence levels according to available clinical documentation, and categorized according to the 9th edition of the nosology and classification of genetic skeletal disorders. Within our dataset, the most frequent groups were Group-1 (FGFR3, chondrodysplasia) and Group-25 (Osteogenesis Imperfecta and decreased bone density). Birth prevalence per 10,000 for the main OCD types, were: Achondroplasia 0.47 (95% CI: 0.38–0.59), Thanatophoric Dysplasia 0.37 (95% CI: 0.29–0.48), and the Osteogenesis Imperfecta group 0.34 (95% CI: 0.26–0.44). For total OCD, birth prevalence was 2.20 per 10.000 births (95% CI: 1.98–2.44). RENAC prevalence of total OCDs was found to be lower than that reported by the Latin-American Study of Congenital Malformations (ECLAMC) and Utah Birth Defect Network but higher than EUROCAT. Our investigation is the first study of OCD prevalence in Argentina using data from every jurisdiction of the country.

Predictors of Extended Length of Hospital Stay Following Surgical Repair of Congenital Heart Diseases.

The purpose of this study is to evaluate post-operative length of stay (LOS) following surgical repair of congenital heart defects (CHD) and to investigate baseline pre-operative factors and predictors of post-operative LOS (pLOS). Retrospective chart review of all cases of corrective surgery for CHD performed at the Pediatric Cardiology Unit, King Abdulaziz University Hospital, Jeddah during January 2013-December 2016. Baseline demographics, clinical factors, pre-operative, intra-operative, post-operative cardiac and extra-cardiac complications were analyzed as independent factors of pLOS using stepwise linear regression. Kaplan-Meier (KM) survival analysis was used to analyze the correlation of pLOS (in days) with the independent variables and estimate the probability to exceeding a given pLOS. A total 191 patients (52.4% male, 49.7% aged ≤ 1year) were included with a median [range] LOS = 10 [3, 158] days. Several baseline clinical factors were associated with longer pLOS such as complex CHD types (tetralogy of Fallot, transposition of great arteries, etc.), high-risk RACHS categories and low weight at surgery. Independent risk factors of pLOS included pre-operative hemoglobin level (unstandardized regression coefficient: B = 2.96, p = 0.036) as the only pre-operative predictor of LOS, besides intra-operative complications (B = 11.72, p = 0.009) and posto-perative factors including MV duration (B = 9.39, p < 0.001), diet/feeding problems (B = 10.27, p = 0.001) and drain tube stay (B = 3.82, p = 0.003). KM survival curves confirmed that these factors increased the probability for longer LOS. Post-operative LOS was associated with several baseline and peri-operative factors; however, it was independently predicted by abnormal baseline hemoglobin level, the occurrence of intra-operative complications, besides post-operative feeding problems, chest drain stay, and MV duration.

MiRNA-208a as a Sensitive Early Biomarker for the Postoperative Course Following Congenital Heart Defect Surgery.

Current clinical risk assessment strategies have poor accuracy for identifying patients who will suffer adverse perioperative events. There is an ongoing need to integrate clinical variables with novel technology and biomarkers to accurately predict outcome after pediatric heart surgery. We tested the hypothesis that miRNAs-208a, -208b, and -499 can serve as noninvasive biomarkers for the extent of myocardial damage and the postoperative clinical course of pediatric patients with congenital heart defects (CHDs) at an early time point following surgery. Serum samples were obtained from 79 pediatric patients before and 6, 12, and 24h after surgery. MiRNAs-208a, -208b, and -499 were quantified by RQ-PCR. Correlations between the patient's clinical variables and miRNA levels were tested. Our results show that the levels of the three miRNAs were elevated at 6h after surgery, remained high at 12h and declined at 24h after the operation. The amount of all three miRNAs at 6h after surgery correlated with surgical and laboratory parameters. Their amount at 12h after surgery correlated with the length of stay at the hospital. Expression levels of miRNA-208a at 6h were related to the appearance of cardiac complications, and could predict whether a patient will sustain complications or will be ventilated for more than 48h after surgery. Circulating miRNA-208a is a predictor for the risk of developing cardiac complications during the postoperative course as early as 6h after heart surgery for CHD in pediatric patients.

Pulmonary Valve Regurgitation: Neither Interventional Nor Surgery Fits All.

Introduction: PV implantation is indicated for severe PV regurgitation after surgery for congenital heart defects, but debates accompany the following issues: timing of PV implantation; choice of the approach, percutaneous interventional vs. surgical PV implantation, and choice of the most suitable valve.Timing of pulmonary valve implantation: The presence of symptoms is class I evidence indication for PV implantation. In asymptomatic patients indication is agreed for any of the following criteria: PV regurgitation > 20%, indexed end-diastolic right ventricular volume > 120–150 ml/m2 BSA, and indexed end-systolic right ventricular volume > 80–90 ml/m2 BSA.Choice of the approach: percutaneous interventional vs. surgical: The choice of the approach depends upon the morphology and the size of the right ventricular outflow tract, the morphology and the size of the pulmonary arteries, the presence of residual intra-cardiac defects and the presence of extremely dilated right ventricle.Choice of the most suitable valve for surgical implantation: Biological valves are first choice in most of the reported studies. A relatively large size of the biological prosthesis presents the advantage of avoiding a right ventricular outflow tract obstruction, and also of allowing for future percutaneous valve-in-valve implantation. Alternatively, biological valved conduits can be implanted between the right ventricle and pulmonary artery, particularly when a reconstruction of the main pulmonary artery and/or its branches is required.Hybrid options: combination of interventional and surgical: Many progresses extended the implantation of a PV with combined hybrid interventional and surgical approaches. Major efforts have been made to overcome the current limits of percutaneous PV implantation, namely the excessive size of a dilated right ventricular outflow tract and the absence of a cylindrical geometry of the right ventricular outflow tract as a suitable landing for a percutaneous PV implantation.Conclusion: Despite tremendous progress obtained with modern technologies, and the endless fantasy of researchers trying to explore new forms of treatment, it is too early to say that either the interventional or the surgical approach to implant a PV can fit all patients with good long-term results.

Oral thyroxin supplementation in infants undergoing cardiac surgery: A double-blind placebo-controlled randomized clinical trial

BackgroundDecreases in serum total thyroxin and total triiodothyronine occurs after cardiopulmonary bypass, and is reflected as poor immediate outcome. We studied effects of oral thyroxin supplementation in infants who underwent open-heart surgery. MethodsIn this prospective study, 100 patients were randomized into 2 groups: 50 in the thyroxin group (TH) and 50 in the placebo group (PL). Patients in the TH group received oral thyroxin (5 μg/kg) 12 hours before surgery and once daily for the remainder of their intensive care unit (ICU) stay. Data on intraoperative and postoperative variables were recorded. Cardiac index (CI) was measured. Perioperative serum thyroid hormone levels and serum interleukin-6 and tumor necrosis factor-α were measured. Secondary analysis was performed by dividing patients into simple and complex subcategories. ResultsResults of the primary analysis indicated a higher CI in the TH compared with the PL. In the complex category, the mean duration of mechanical ventilation was 3.85 ± 0.93 and 4.66 ± 1.55 days in the TH and PL, respectively (P = .001). Mean ICU stay was 6.79 ± 2.26 and 8.33 ± 3.09 days (P = .03), and mean hospital stay was 15.70 ± 4.77 and 18.90 ± 4.48 days (P = .01) in the TH and PL, respectively. There were no significant differences between the TH and the PL in the simple category. CI was higher in the TH at all time points (P = .004). The average therapeutic intervention scoring system scores for the first 2 days were higher in the PL in the complex category. ConclusionsOral thyroxin supplementation improves the CI and reduces the inotropic requirement. In addition, it reduces the duration of mechanical ventilation, ICU and hospital stay, and therapeutic intervention scoring system in infants after surgery for complex congenital heart defects.

Abstract P-550: ARRHYTHMIAS IN POST OPERATIVE CARDIAC CHILDREN: FREQUENCY AND OUTCOME FROM A TERTIARY CARE PEDIATRIC ICU

Aims & Objectives: To determine the frequency and diagnosis of paediatric arrhythmias in the postoperative period following congenital cardiac surgery Methods This is a Prospective observational study conducted at a major tertiary care hospital in Karachi, Aga Khan University Hospital. The study was reviewed by the institution’s ethics review committee (ERC) prior to data collection.Subjects:Data from all patients, newborns to 16 years of age, admitted to pediatric cardiac intensive care unit (PCICU) of Aga Khan University hospital after surgery for congenital heart defects during the period of 1st January 2014 to 31st December 2015, were included in the study.Patients with haemodynamically stable significant arrythmias were identified.Electrocardiograms were analysed by a pediatric intensivist and/or a cardiologist. Results Five hundred and forty five patients underwent congenital heart surgery in the study period. A total of forty four cases developed arrhythmias post-operatively. The mean age of the 31 males and 13 females was 38.75 months. A higher incidence of arrhythmias was observed in males than females. Amongst the arrythmias, Junctional Ectopic Tachycardia(JET) (18.2%),was the most frequently encountered arrythmia.Most arrhythmias were observed in the first 24 hours after the surgery and were observed after Tetralogy of Fallot repair. Age, gender and cross clamp time were significant associations with post operative arrhythmias. Conclusions Arrhythmias are common after pediatric cardiac surgery. JET is the most common type of tachyarrhythmia seen during early postoperative care.Prolonged CBP time is associated with post operative arrhythmias.Postoperative arrhythmias can be life-threatening tachyarrhythmia and need to be recognized and managed immediately.

Abstract P-293: ACUTE KIDNEY INJURY AFTER CONGENITAL HEART SURGERY: FREQUENCY, RISK FACTORS AND OUTCOMES USING KIDGO CLASSIFICATION. A SINGLE CENTER EXPERIENCE

Aims & Objectives: objectives: To determine the frequency, risk factors and outcome of AKI in post-operative patients undergone CPB surgery for congenital heart defects. Methods We conducted a retrospective Matched (age and gender) case control study 1:1 with a sample size of 474 (237 cases and 237 controls). We used the KHIGO criteria to define acute kidney injury. Severe acute kidney injury was defined as stage 2 or 3 acute kidney injury (plasma creatinine level ≥2 times the baseline level or urine output <0.5 ml per kilogram of body weight per hour for ≥12 hours) and was assessed for the first 7 days of intensive care. Data was collected on a structured proforma and all the preoperative, intraoperative, postoperative and follow up details were collected. P value along with odds ratio and 95% confidence interval were reported. Results A total of 840 patients underwent CPB surgery, 237(28%) patients developed AKI. Stage II & III were seen the most, 101(42%) and 103(43%) respectively. Prolonged cardiopulmonary bypass time (AOR: 1.013, 95% CI: 1.008- 1,019, p value < 0.005) and cyanotic heart diseases (AOR: 1.87, 95% CI: 1.18- 2.97, p value 0.008) were found to be significant risk factors on multivariate analysis. 227(95%) patients showed resolution. 4(2%) patients required peritoneal dialysis. 10 (5%) patients expired had associated multiorgan failure. No patients with resolution were followed in clinic for assessment of renal function. Conclusions AKI in post-operative cardiac surgery patients is common. It can be prevented by avoiding the prolong cardiopulmonary bypass time and early repair in cyanotic heart diseases.

Electrospun Gelatin⁻Chondroitin Sulfate Scaffolds Loaded with Platelet Lysate Promote Immature Cardiomyocyte Proliferation.

The aim of the present work was the development of heart patches based on gelatin (G) and chondroitin sulfate (CS) to be used as implants to improve heart recovery after corrective surgery for critical congenital heart defects (CHD). Patches were prepared by means of electrospinning to obtain nanofibrous scaffolds and they were loaded with platelet lysate (PL) as a source of growth factors to further enhance the repair process. Scaffolds were characterized for morphology and mechanical properties and for the capability to support in vitro adhesion and proliferation of dermal fibroblasts in order to assess the system’s general biocompatibility. Adhesion and proliferation of endothelial cells and cardiac cells (cardiomyocytes and cardiac fibroblasts from rat fetuses) onto PL-loaded patches was evaluated. Patches presented good elasticity and high stiffness suitable for in vivo adaptation to heart contraction. CS improved adhesion and proliferation of dermal fibroblasts, as proof of their biocompatibility. Moreover, they enhanced the adhesion and proliferation of endothelial cells, a crucial mediator of cardiac repair. Cell adhesion and proliferation could be related to elastic properties, which could favor cell motility. The presence of platelet lysate and CS was crucial for the adhesion and proliferation of cardiac cells and, in particular, of cardiomyocytes: G/CS scaffold embedded with PL appeared to selectively promote proliferation in cardiomyocytes but not cardiac fibroblasts. In conclusion, G/CS scaffold seems to be a promising system to assist myocardial-repair processes in young patient, preserving cardiomyocyte viability and preventing cardiac fibroblast proliferation, likely reducing subsequent uncontrolled collagen deposition by fibroblasts following repair.

Sinus tachycardia presenting as a wide and narrow complex tachyarrhythmia: What is the ‘link’?

We describe a neonate that developed alternating wide and narrow complex tachycardias following heart surgery for congenital heart defect. Although the etiology was sinus tachycardia, a premature atrial complex initiated aberrancy due to phase 3 block that was perpetuated due to ‘linking’ at similar or even slower heart rates. Similarly, there was abrupt transition from wide to narrow complex tachycardia following a premature ventricular complex without a change in subsequent heart rate. This was explained by interruption of linking phenomenon by premature ventricular activation. While the above mechanisms are described in the setting of a supraventricular tachyarrhythmia, this has not been reported during sinus tachycardia.

Association between histological alterations in the thymus and sudden infant death syndrome

IntroductionSudden infant death syndrome (SIDS) involves the death of an infant during the first year of life and it is among the leading causes of infant mortality worldwide. One hypothesis regarding the pathogenesis of SIDS is that it results from a combination of three independent factors: endogenous vulnerability, a critical time window during postnatal development, and exogenous stressors. This hypothesis is known as the “triple-risk model”. MethodsIn this study, we used an immunohistological approach to compare the cellular microenvironments of thymuses from 19 infants whose sudden death was classified as SIDS and a control group, which consisted of thymuses from age-matched children undergoing surgery for various congenital heart defects. We hypothesized that morphological signs of stress-related thymic involution would be present. ResultsBased on our observations, we found evidence that the proliferation and maturation of T-lymphocytes in the thymuses of infants with SIDS were suppressed. We observed enhanced macrophage activity, suggesting an increase in the apoptosis of lymphocytes and decrease in number of thymic dendritic cells and myoid cells. Significant apoptosis of thymic lymphocytes without cell regeneration typically leads to atrophy of the thymus. All cellular events we observed resemble the initial stage of stress-related thymic involution. ConclusionThese results support the “triple-risk model,” suggesting that certain exogenous stressors might be involved in the pathogenesis of SIDS. This was probably not recognized during the autopsies of infants who died suddenly.